What other factors negatively affect adherence to ART?
There are other factors unrelated to patients or to the healthcare professional that result in poor adherence. The most common ones are the large number of tablets to be taken, high frequency of doses, and common side-effects like nausea and vomiting. Pill burden is one of the key factors that can affect adherence negatively. These factors are relatively easy to deal with — for example, patients may simply need reassurance about the treatment's side-effects, or a change in the frequency of doses (twice versus three times per day). Other factors, especially those associated with drug interactions and food restrictions towards different drugs, may require referral to an appropriate health facility or hospital for counselling and other support services.
A patient on ART in your community tells you that he wants to stop taking his cotrimoxazole prophylaxis medication because he is also taking ARV drugs. He describes how difficult it is to take so many tablets in a day. What advice will you give him?
Reassure the patient that drugs should be taken as prescribed by the health professionals. As you are not allowed to stop any of the drugs, refer him for further support.